Other Options

Surgery

What is it?

Not everyone with stage III or IV melanoma is suitable for surgery – it depends where your melanoma has spread to, and in how many places you now have tumours. Your doctor will tell you whether you are suitable for surgery and how complex it is likely to be. They may recommend following surgery with another treatment, such as targeted treatment or immunotherapy. Surgery in this situation is usually considered if there are just one or two areas of melanoma, which have not changed significantly over a period of 3-6 months. It is also important to recognise the consequences of attempting surgery; your surgeon will discuss the potential benefits versus the risks and consequences of any planned surgery with you.

Risks and side effects

Risks and side effects will vary, but all surgery carries risks. Depending on the location, size and number of secondary tumours, you may risk infection, bleeding and blood clots. You may be in pain afterwards, but you will be given medication to help alleviate this. Other side effects will depend on the location of the secondary tumours.

More information on surgery to treat melanoma that has spread to other parts of the body (or ‘metastasised’) is available here.

Radiotherapy

What is it?

Melanoma deposits in some parts of the body may be suitable for targeted radiotherapy (stereotactic radiotherapy) which may be known as Gamma Knife or CyberKnife.  Radiotherapy (or radiation therapy) might be offered to shrink tumours (particularly in the brain) and relieve symptoms. Radiotherapy involves using an X-ray machine focused to administer high energy rays of radiation to the treatment area. This doesn’t usually take more than a few minutes, and you won’t feel anything while it’s happening. You may just have a single treatment, or you may have several treatments each week over a number of weeks.

Your doctor will discuss with you the probabilities of treatments working and the potential side effects.

Risks and side effects

You can usually have radiotherapy as a day patient, and so will need to travel to the hospital for this. It might make you feel quite tired.

The most common short-term side effects of radiotherapy are reddening and/or sore skin and hair loss, but these occur only in the area being treated. In addition, you may experience some tiredness. Long term side effects will vary according to where the radiation was targeted on your body. More information on radiotherapy for the treatment of melanoma is available here.

Electrochemotherapy

What is it?

This is a procedure which involves injection of a drug (bleomycin – a chemotherapy drug) either into the body or just into the melanoma itself. The drug itself is too big to get inside the melanoma cell, so an electrical current is needed to open the cell gates (similar to house electric gates, needing a switch to open them, before the car drives in). This treatment is not limited to just the limbs and can be considered for skin recurrences anywhere. Bleomycin destroys the cancers cells it gets into and so can help control the melanoma and may remove it altogether, but the treatment may need repeating.  Depending upon your general health, this treatment option may be suitable for you.

Ablation (burning of melanoma recurrences), using either a laser, or electrical current can be used to treat small melanoma that come back in the same area. This would be done under either a local anaesthetic (you would be given a local anaesthetic to numb the area beforehand, but you still may feel some discomfort in the skin during the treatment) or general anaesthetic if there is a large area to treat.

Risks and Side effects

Pain, nausea and skin changes.  Bleomycin may cause scarring on the lungs, so you will need to see an oncologist to discuss the risks.

More information on electrochemotherapy can be found here

Talimogene laherparepvec (T-VEC)

What is it?

Talimogene laherparepvec (or T-VEC) is a genetically modified virus that is designed to infect and kill melanoma cells. It has to be injected directly into tumours, so is only suitable for people who have lumps that can be felt (e.g. skin lumps or lymph nodes) with no disease in internal organs. It is considered when surgery is not an option. Ultrasound guidance may be needed to make the injection safer. The virus helps to stimulate the body’s own immune system to potentially remove the melanoma.

T-VEC is injected directly into your tumour(s). After the initial treatment, a second dose is given three weeks later with additional doses given every two weeks for at least six months, until there are no remaining injectable tumours to treat or other treatment is required.

You should keep the injection site covered for 48 hours after treatment, and discard dressings in the bin provided by the hospital.

Risks and side effects

Tiredness, chills, fever, rashes, feeling sick, flu-like symptoms and pain at the injection site.

For more information on T-VEC can be found here

Supportive Care

What is it?

After discussion with your medical team, you might decide you don’t want any treatment, or further treatment, for your stage IV melanoma.  Your medical team will still be able to offer treatments that will alleviate the symptoms without necessarily treating your melanoma, including pain relief. Even if you do have any of the treatments outlined above you may still require help with management of symptoms. You may also be referred to a community-based palliative care service for symptom control, emotional support and practical help.

Risks and side effects

If untreated, the melanoma may cause a number of symptoms as the tumours grow and/or spread to other parts of your body. Your medical team can discuss ways of managing these symptoms, including pain relief and emotional and practical support.  Deciding against treatment means that you face the risks associated with the melanoma tumours growing and/or spreading to other parts of your body. The symptoms will vary between different people, depending on where you have secondary tumours. Unless you die from something else, the melanoma will eventually be fatal.
For supportive information resources, please click here

click to progress